Introduction
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When a life is touched by a cancer diagnosis, whether it be your own, a family member's, or a friend's, many questions immediately come to mind. Oftentimes the first concerns are about treatment issues such as, "Will I have to have chemotherapy or radiation?", "What is it like to get a treatment?", "How will I manage my side effects?", "What will the needs of my family be?". Other pressing concerns many people report are in the area of nutritional and emotional support. "What can I eat now to maintain or increase my weight?", "Are anti-oxidants a good supplement for me to take now?", "How do I talk to my family about my diagnosis?", "Where can I find a support group to help me through this process?".
This webpage is designed to address these issues. The day-to-day concerns are addressed as well as the intermittent problems one might face as they travel the road to recovery.
How Do I Make My Chemotherapy Treatment Easier
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Question: Every time I have a chemotherapy treatment I get extremely nervous. It usually takes a few tries to get in the IV. Is there anything I can do to make this experience easier?
Answer: There are several things you can do. Relaxing is key.
The night before, do something pleasurable such as seeing a movie or going out to dinner. If you are too tired or not feeling well, a simple foot or hand massage may be nice, along with a warm bath with some lavender oil.
Remember to keep yourself well-hydrated. Drink at least 6-8 glasses of fluid per day for the few days before your injection.
At the time of the injection, you may want to bring a cassette player with earphones so you can listen to some soft music, or a relaxation tape.
Ask that the nurse wrap your arm in a warm, wet towel for at least five minutes. This allows the veins to dilate and the skin to soften. Also, you can request that the smallest possible needle be used. You may even want to use EMLA cream. EMLA cream is applied to the veinipuncture site at least 30 minutes before an IV is started. It numbs the area for about 20 minutes. You will need a prescription from your oncologist for this medication.
Breathe slowly and easily, and refrain from holding your breath while the IV is being inserted. After the IV is in place, you can request a warm towel to be wrapped around the site to keep the veins dilated. This is also a nice addition if you are being infused with a solution that is cold, i.e. blood transfusions. Having an IV placed can be an uncomfortable experience.
Using some of the techniques described above may help make the experience a little more tolerable
What Can I Do To Avoid an Infection
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Question: My doctor told me that I would be at increased risk of infection during certain times in my treatment process. What can I do to be sure I do not get an infection?
Answer: Your doctor was referring to a condition called neutropenia. Neutropenia means you have a low white blood cell (neutrophil) count. White blood cells are the cells in our bodies that fight infections. There are differect kinds of white blood cells that attack the different kinds of pathogens we are exposed to on a daily basis. Some white blood cells attack bacteria, primarily neutrophils, some attack molds and fungus, and others are responsible for the allergic response. Your doctor will monitor your Complete White Blood Count (CBC) very carefully throughout your chemotherapy treatments. Your Absolute Neutrophil Count (ANC) is also monitired very carefully to be sure you are within the safe range for receiving chemotherapy. After receiving chemptherapy, usually 10-14 days after, your white blood cell count will dip very low. It is at this time you are at the greatest risk of contracting an infection.
One of the most effective means of protecting yourself is through frequent handwashing, using gentle soap and lots of warm, running water. The longer you lather, the better.
In addition:
- Avoid exposure to people with obvious infections. If you have small children at home, this may be a challenge. Just do the best you can.
- Wear gloves while working around the house or garden. Try to avoid nicks and scratches.
- Other tips for skin care: shower daily with warm water, using a lotion after showering to keep your skin soft and avoid excess drying; keep the skin around the anus clean and dry; use special creams or sitz baths if you are experiencing hemorrhoids, never use suppositories, rectal thermometers or any other rectal manipulation during the time your WBC is at its lowest.
- When brushing teeth, use a soft toothbrush and a gentle hand. Use a mouthwash that does not contain alcohol. Alcohol can be drying and uncomfortable. Gentle flossing is good.
- Always get adequate rest and exercise during your treatments.
- Try to maintain a balanced diet to get all the nutrients you need.
Despite all these efforts, you may still get an infection. Monitor yourself for symptoms of infection: hot or flushed skin, temperature of 101.5 or more, rapid heartrate, cough, burning with urinationor cloudy, foul smelling urine, any breaks in the skin that are hot, painful, red, swollen, or draining. The most common presentation of infection is an elevated temperature. If you are neutropenic and have a fever, this is an emergency and you need to seek immediate medical help.
If you are chronically developing infections during your treatments, related to neutropenia, or you are skipping treatments and not staying on your planned protocol because of neutropenia, your oncologist may prescribe a drug called Neupogen. Neupogen is an injectable medication that increases the production of white blood cells. Neupogen is onl;y used when absolutely necessary because of its cost and the need for daily self-injections.
Will I Lose My Hair with the Chemotherapy
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Question: My Doctor tells me I will lose my hair with the chemotherapy I'm taking. Is there any way I can avoid this or decrease the amount I lose.
Answer: Many chemotherapy agents cause hair loss otherwise known as alopecia. Chemotherapy affects the growth of rapidly reproducing cells. The cells that make hair are rapidly reproducing hence, they are affected. Some chemotherapies will cause all the hair to fall out (Taxol, Adriamycin). Some will cause the hair to thin.
Hair loss usually starts to occur within one to three weeks after the initiation of treatment. You will need to discuss the affect your chemotherapy will have on your hair with your MD. Since chemotherapy is such a strong agent, there is little you can do to avoid hair loss altogether. Years ago, ice caps (giant ice wraps around your head), and tourniquets around the scalp were popular. They were not very effective mostly due to the discomfort of wearing them throughout the treatment. Also, it was dangerous for those persons who were at risk of developing scalp or skin metestases. Chemotherapy medications act on fast growing cells for a period longer than most people can wear an ice cap or tourniquet.
You can slow the rate of hair loss by being gentle with your hair. Wash only as needed, do not pull on hair or use rubberbands. Use gentle soaps. Avoid heat generating hair appliances such as blow dryers and hot rollers. Do not color or perm hair during this time. If you are interested in wearing a wig, consider trying them on before you lose your hair. It's nice to match color, style and thickness. Hair loss is one of the most distressing side effects of chemotherapy. It is an outward reminder of what you are going through.
Remember, your hair loss is temporary. Your hair will grow back after treatment is ended. You will notice hair growth usually within a month after your last treatment. Your hair may come back a different shade or texture. Remember too, your hair acts as an insulation to your head. You may notice you feel much colder after you have lost your hair. Hats and scarves can provide the extra insulation you need to keep your head warm.
What Can I Do to Relieve My Discomfort with Mucous Membrane Sores
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Question: Since starting chemotherapy treatments, I've been experiencing sores inside my mouth and sometimes pain down my throat. Why is this happening and what can I do to relieve my discomfort?
Answer: Most chemotherapies are designed to act on rapidly reproducing cells and they are not cell specific. This means chemotherapy does not recognize cancer cells, it acts on all cells that are rapidly reproducing. The cells that line the gastrointestinal tract-from the mouth, down the esophagus, into the intestines, and out the rectum are especially vulnerable to the effects of chemotherapy since the cells in these areas are constantly reproducing and replacing themselves. Other skin areas especially vulnerable to the effects of chemotherapy include the mucous membranes. These areas are found in the nose, sinuses, and genital regions. The most common time for sores in these areas to develop is when you are at your nadir. This happens 10-14 days after you have received your chemotherapy. Certain chemotherapies are especially prone to causing sores.
Preventative measures and treatment of oral sores is focused on good oral hygiene. Keeping the mouth clean through the use of gentle tooth brushing, gentle flossing (provided there is no risk of bleeding) and alcohol free rinses after all meals and at bedtime is a great way to avoid infection in the mouth. A great homemade mouthwash includes: 8 oz warm water, 1 teaspoon salt, 1 tbsp baking soda. Shake together right before rinsing as this solution wants to separate. Even with all your efforts to keep your mouth clean, you may still experience mouth sores. The goal of treatment here is to provide pain relief and prevent super-infection. There are many rinses that contain anti-fungal, anti-biotic medication, as well as numbing agents that can be prescribed by your MD to aid in these areas. Some of these rinses can be swallowed to treat any esophageal sores that may be present. Some examples of oral remedies include: Benedryl elixer, lozenges and analgesics. Swishing with anesthetic viscous Xylocaine or Hurricaine (benzocaine) can aid in eating if you have sores in the mouth. Swish with one tablespoon viscous xylocaine before meals, or use a Q-tip to apply directly to the sores. Swishing diluted Milk of Magnesia, Carafate slurry or Mylanta in the mouth may help with discomfort. A good cocktail to try is, 1 tbsp Cherry Maalox, 1 tsp Nystatin, ½ tsp Hurricaine Liquid. Mix ingredients together and rinse in mouth for one minute. Also, certain rinses or topical applications can be used in the genital area if sores are occurring there. Some cases of mucositis can be so painful that systemic treatment is required. Medications such as Vicodin or Morphine may be used. Be sure to be assessed by your MD before you try any remedies, it is extremely important that any unusual skin infections are ruled out before treatment is started. During the time sores are present, avoid spicy, too hot or too cold foods. Increase fluid intake as allowed by your condition. This will keep your saliva watery and help keep your mucous membranes moist. If rectal or perineal sores are present, avoid irritants such as tampons, rectal thermometers or suppositories and intercourse until the sores are healed and painless. Sitz baths as well as pre-moistened tucks towelettes can provide temporary relief
What Are Some of the Medications I Can Take for Nausea
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Question: What are some of the medications I can take for nausea and how should I take them?
Answer: Many of our chemotherapy agents can cause nausea ranging from severe, to just mildly irritating nausea. There are also quite a few chemotherapy agents that do not cause nausea at all. Be sure to ask your MD if the chemotherapy you will be receiving will cause nausea and to what extent.
There are many different kinds of medications that are used to control nausea. The following is a list of medications and how they are generally prescribed. As always, be sure to discuss any kind of medication regime with your healthcare practitioner before embarking.
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Prochlorperazine (Compazine) is one of the first line treatments used for nausea. It can be given orally, rectally, or intravenously. It is usually prescribed as a pill to be taken every eight hours. It can cause some drowsiness. In a small percentage of the population it can cause a dystonic reaction. This reaction is manifested in a tightening of the jaw and neck areas and can even cause the head to spasm to one side. If this occurs, call your MD immediately and never use Prochlorperazine again. Be sure to include it on your list of medications that you are allergic to. Remember, this is an extremely rare happening.
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Lorazepam (Ativan) is often prescribed to treat nausea. It also acts as an anti-anxiety medication, thus it may be useful for those who are uncomfortably nervous when they are receiving chemotherapy. It is usually prescribed as a pill, but it can be given intravenously. It is usually taken every 4-6 hours on an as- needed basis. Lorazepam can be taken in conjunction with Prochlorperazine. Lorazepam tends to be fairly sedating so, if it is used in combination with other sedating medications, this effect will be increased.
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Metoclopramide(Reglan) can also be used to treat nausea. It speeds gastric emptying thereby reducing the irritation of the abdominal wall. It is usually given every 6-8 hours on an as-needed basis. In very rare instances, Metoclopramide can cause extra-pyramidal symptoms. These include shakiness of the extemities and uncontrolled movements of the face. If this unusual happening occurs, it is usually noticed in the first 24-28 hours of use and with doses that exceed 30-20 mg per day. If you ever experience these reactions, contact your MD immediately.
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Granisetron (Kytril) and Ondansetron (Zofran) are two fairly new medications that have remarkably changed the tolerance of chemotherapy treatment. These medications work within the stomach and on the surrounding nerves to stop nausea. They can be given intravenously or orally. Oral dosing is usually every 8-12 hours. Of all the anti-nausea medications, these are the few that do not cause sedation. The drawback of these medications is they tend to be very expensive and some insurance companies will not approve their use as a first line treatment.
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Dexamethasone (Decadron) is a corticosteroid that has a mild antinausea effect. When combined with other antinausea medications, an overall enhancement of effect can occur. Sometimes patients will report a feeling of boosted energy on the day they receive Dexamethasone. This is one of the characteristics of steroids.
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Marinol (THC) is often times prescribed to patients for whom other medications have been ineffective. It is a derivitive of the marajuana plant. It can cause sedation, dizziness, dry mouth, increased appetite. Many people dislike the sensations Marinol can produce. As an oral agent it has been reported to offer mild relief from nausea. Many people claim that the smoking marajuana provides better nausea relief than the oral version. Be aware that possessing this drug without a prescription is illegal. Marinol is often prescribed to be taken 2-3 times a day.
What are Vascular Access Devices
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Question: I've been hearing a lot about devices that can be used instead of my getting needlesticks with every treatment. What are these devices?
Answer: What you are referring to are called Vascular Access Devices. There are a number of different kinds of devices that can be placed in the body to offer venous access so that a needlestick is not necessary to draw blood or give a treatment.
Some of these devices exit the body and look like small, thin white tubes. They can be placed in a large vein in the arm (PICC), usually in the crook of the arm. They can also be placed in the chest (Hickman or Hone). These devices are fed into the vein and up to the large subclavian vein in the chest and close to the heart.
- Since these devices exit the body, there is daily or weekly cleaning that must be done to maintain the device. Usually your nurse will perform these maintenance duties for you. Some people learn how to do it themselves.
Other devices are completely covered under the skin. These are referred to as mediports or portacaths. These devices require a surgical procedure to be placed.
- (The other devices are placed using topical anesthesia only.) These devices are mostly placed in the upper chest area and look like a half-dollar size bump under the skin. These devices do require a needlestick however, it is usually a quick stick not requiring the searching so often needed with peripheral venous access.
There is also a numbing cream your doctor can prescribe for you that is applied 1 hour before you expect to be stuck. This cream is remarkable in numbing the area and making the whole process painless.
With both kinds of access devices, the internal and the external, blood can be drawn and treatments can be given. Likewise, these devices do carry with them the risk of infection as well as blood clot formation along the length of the tube. If you are thinking you may be a candidate for either of these devices, you will need to discuss this with your oncologist.
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